13 Monitoring Cardiac Output
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Editing and Saving RH C.O. Measurements
It is important to identify and reject erroneous measurements (called "trials"), as the monitor uses all
the measurement trial values you do not reject to calculate the averaged cardiac output.
1 Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider
the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth
peak and returns to the temperature baseline level after the peak.
2 Reject unsatisfactory trials: use the Select Trial pop-up key to move between trials, then select the
Accept Reject pop-up key to accept or reject trials. If you are using a touch screen you can accept
or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The
background of rejected trials is red and the background of accepted trials is green. The monitor
recalculates the average values after you reject or accept trials.
If all values are different from each other, there may be true hemodynamic instability caused, for
example, by severe cardiac arrhythmia.
3 Save average C.O. values. To close a measurement series, you must save the average values by
selecting the pop-up key
Save C.O.. This sends the average C.O. numeric to be displayed on the
main screen, and stores the averaged values in the trends and calculations databases.
Documenting C.O. Measurements
You can document C.O. measurements on the default printer or recorder.
1 In the procedure window, select the pop-up key Print/ Record.
2 From the pop-up list, choose:
–
Print Results to print the contents of the procedure window
–
Record Results to record the contents of the procedure window
–
Record Trial to send an individual trial curve to the recorder.
C.O. Injectate Guidelines
The greater the injectate volume and the colder the temperature, the more accurate the measurement.
Reduced injectate volume or higher injectate temperature may reduce the specified accuracy.
For adult patients, to ensure the greatest measurement accuracy, use a cold injectate (< 8°C) of 10 ml
volume, if not contra-indicated by the patient's condition. Your choice of injectate volume should be
based on the injectate temperature and the patient's cardiac output.
Guidelines for Right Heart Thermodilution C.O. Injectate
If you are using the right heart thermodilution method, the use of injectate with a temperature less than
8°C lower than the blood temperature may cause incorrect values for the thermodilution.
Guidelines for PiCCO C.O Injectate
If you are using the PiCCO method, the use of injectate with a temperature that is not at least 12°C
lower than the blood temperature may cause incorrect values for the thermodilution and CCO
calibration.
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